1. What is the StrataPT Medicare Fee Calculator?

The StrataPT Medicare Fee Calculator estimates payment amounts for physical therapy services under Medicare using the Relative Value Unit (RVU) system and Geographic Practice Cost Indices (GPCI).

2. How Does the Calculator Work?

The calculator uses the Medicare fee formula:

Where:

• \( wRVU \) — Work Relative Value Units
• \( wGPCI \) — Work Geographic Practice Cost Index
• \( peRVU \) — Practice Expense RVUs
• \( peGPCI \) — Practice Expense GPCI
• \( mpRVU \) — Malpractice RVUs
• \( mpGPCI \) — Malpractice GPCI
• 32.35 — 2023 Medicare conversion factor (adjust annually)

Explanation: The equation calculates total payment by combining weighted components for work, practice expenses, and malpractice costs, adjusted for geographic location.

3. Importance of Medicare Fee Calculation

Details: Accurate fee calculation helps physical therapy practices understand reimbursement rates, plan finances, and negotiate contracts with Medicare.

4. Using the Calculator

Tips: Enter all RVU and GPCI values accurately. RVUs are typically whole numbers or simple decimals, while GPCIs are precise factors (usually between 0.8-1.2).

5. Frequently Asked Questions (FAQ)

Q1: Where can I find the RVU values for specific CPT codes?
A: RVU values are published annually by CMS in the Medicare Physician Fee Schedule.

Q2: How often do GPCI values change?
A: GPCI values are typically updated every 3 years, though interim changes may occur.

Q3: What is the current conversion factor?
A: As of 2023, it's $32.35, but this changes annually. Always verify the current year's factor.

Q4: Does this calculator account for modifiers?
A: No, this calculates base fees only. Modifiers may adjust final payment amounts.

Q5: Are there different GPCIs for urban vs rural areas?
A: Yes, GPCI values vary by geographic locality, which may be urban, rural, or frontier.